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Joel E Fishman

Publications and source records attributed to Joel E Fishman.

10 recordsLinked to original sources
PubMed2003

US-guided core-needle biopsy of the breast: how many specimens are necessary?

PURPOSE: To analyze the diagnostic yield for each specimen obtained at 14-gauge ultrasonography (US)-guided breast biopsy and compare these findings with mass, procedural, and specimen characteristics that could affect yield. MATERIALS AND METHODS: Seventy-three consecutive biopsies of breast masses were performed by using a 14-gauge handheld biopsy device. Each specimen was graded for whether it was nonfragmented or fragmented and for whether it sank or floated, and each pass was graded for whether or not the needle passed through the lesion. Each specimen was mounted on a separate slide. A pathologist who was unaware of the final diagnoses reviewed the slides in random order. A diagnosis was determined for each specimen whenever possible, and diagnostic yield was calculated as a function of number of passes. The Fisher exact test was used to compare yield for different specimen characteristics. RESULTS: Fourteen (19%) lesions were malignant and 59 (81%) were benign. Cells indicating the final diagnosis were contained in 249 (75%) of 334 specimens. Cells indicating the diagnosis were contained in the first specimen in 51 (70%) lesions, in the second specimen in 67 (92%), in the third specimen in 70 (96%), and in the fourth specimen in 73 (100%). Of the 14 malignancies, 13 (93%) were diagnosed with cells contained in the first or second specimen; one cancer (ductal carcinoma in situ) was diagnosed with cells contained in the fourth specimen. Specimens that were nonfragmented (P <.001) and sank (P <.001) showed correlation with being diagnostic, but needle visualization within the lesion did not. CONCLUSION: A minimum of four specimens, preferably those that are nonfragmented and that sink, should be obtained with 14-gauge US-guided breast biopsy.

Biopsy, Needle↗
PubMed2003

Multislice CT in thoracic trauma.

The introduction of CT imaging in the 1970s revolutionized all aspects of medical care, perhaps nowhere more so than in the evaluation of acutely injured patients. Just as single-slice helical scanning was a great advance over conventional CT, the capabilities of MSCT are proving to be dramatically superior to single-slice methods. Improved contrast bolus imaging, thinner slices, and isotropic voxels should enable the trauma radiologist to identify both major organ system disruption and subtle injuries more promptly. Multiplanar and three-dimensional reconstructions, a forte of MSCT, facilitate rapid communication of disease states with surgeons and others involved in the care of injured patients. In many centers, whole-body CT is beginning to supplant plain films of the chest and spine in the evaluation of severe trauma victims; the cost-effectiveness of such methods is still under evaluation.

Humans↗
PubMed2003

MR evaluation of arrhythmogenic right ventricular cardiomyopathy in pediatric patients.

OBJECTIVE: The aim of our study was to correlate the findings of three MR imaging sequences with the clinical findings of possible arrhythmogenic right ventricular cardiomyopathy in pediatric patients. MATERIALS AND METHODS: Twenty-six consecutive pediatric patients underwent MR imaging with ECG-gated non-breath-hold spin-echo T1-weighted non-fat-suppressed and fat-suppressed sequences. The MR images were evaluated for thinning or fat signal in the right ventricular wall and for enlargement or increased trabeculation of the right ventricle or right ventricular outflow tract. Cine MR imaging was used to assess wall motion abnormalities. Cardiac biopsy was performed in 17 patients. Biopsy results and other clinical findings suggesting arrhythmogenic right ventricular cardiomyopathy were tabulated. RESULTS: Two MR imaging studies were of poor quality as a result of arrhythmias, and one study was incomplete. In the 23 remaining patients, there were (mean +/- SD) 1.5 +/- 1.0 and 0.8 +/- 1.0 findings of possible arrhythmogenic right ventricular cardiomyopathy in the non-fat-suppressed and the fat-suppressed sequences, respectively. Fat-compatible signal in the myocardium was detected in 16 (70%) of 23 non-fat-suppressed studies and in five (22%) of 23 fat-suppressed studies (p = 0.003). The non-fat-suppressed sequence had a higher sensitivity (75% vs 43%) and a lower specificity (38% vs 75%) for fatty infiltration than did the fat-suppressed sequence when correlated with the biopsies. The linear correlation between all MR findings and all clinical diagnostic criteria, including biopsy, was better for the combination of cine and both T1 sequences (r = 0.58) than for the non-fat-suppressed (r = 0.53) or fat-suppressed (r = 0.46) T1 sequences alone. CONCLUSION: MR imaging showed moderate correlation with the clinical criteria in the diagnosis of arrhythmogenic right ventricular cardiomyopathy.

Adolescent↗
PubMed2002

Update on lung disease in AIDS.

Pulmonary disorders remain an important complication of HIV infection, even in the current era of potent antiretroviral therapy. Using an integrated approach that combines radiographic pattern recognition with knowledge of a patient's clinical symptoms, laboratory data, immune status level, demographic information, and drug therapy can enhance the interpretation of imaging studies in HIV-infected patients. Although chest radiography remains the mainstay of imaging the HIV-positive patient with respiratory symptoms, CT plays an increasingly important secondary role in selected cases.

AIDS-Related Opportunistic Infections↗
PubMed2002

The imaging spectrum of pulmonary tuberculosis in AIDS.

SUMMARY: Pulmonary tuberculosis (TB) is the major opportunistic infection of acquired immunodeficiency syndrome (AIDS) on a worldwide basis. The purpose of this pictorial essay is to illustrate and review the spectrum of imaging findings associated with pulmonary TB in patients with AIDS and to describe important factors that may complicate the radiographic follow-up of patients being treated for TB.

AIDS-Related Opportunistic Infections↗
PubMed2002

Thoracic radiology in kidney and liver transplantation.

Renal transplantation accounts for more than half of all solid organ transplants performed in the U.S., and the liver is the second most commonly transplanted solid organ. Although abdominal imaging procedures are commonplace in these patients, there has been relatively little attention paid to thoracic imaging applications. Preoperative imaging is crucial to aid in the exclusion of infectious or malignant disease. In the perioperative time period, thoracic imaging focuses both on standard intensive care unit care, including monitoring devices and their complications, and on the early infections that can occur. Postoperative management is divided into three time periods, and the principles governing the occurrence of infections and malignancies are reviewed. Anatomic and pathologic aspects unique to kidney and liver transplantation patients are also discussed.

Adult↗
PubMedDate not supplied

Pitfalls in the diagnosis of acute pulmonary embolism on spiral computer tomography.

Spiral computer tomography (CT) has become a widely accepted clinical tool in the diagnosis of acute pulmonary embolism. The accuracy of computed tomography in diagnosing pulmonary embolism has increased over the past 10 years, parallel to technological improvements. However, as with most imaging techniques, interpretative pitfalls may occur for a variety of reasons. These include technical problems caused by respiratory motion artifact, improper bolus timing, streak artifact, and patient body habitus. In addition, misinterpretation of normal bronchovascular anatomy may lead to an erroneous diagnosis. This article discusses the various diagnostic pitfalls and methods to minimize and overcome them.

Artifacts↗